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22 Cards in this Set
- Front
- Back
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Positive Symptoms
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Combativeness and agitation
Delusion Disorganized speech Hallucinations Unusual behavior |
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Negative Symptoms
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Alogia
Anhedonia Avolition Blunted Affect Lack of Socialization Loss of Emotional Connectedness |
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Schizophrenia Subtypes
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Paranoid Schizophrenia
Disorganized Schizophrenia Catatonic Schizophrenia Undifferentiated Schizophrenia Residual Schizophrenia |
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Aripiprazole
CYP? AE? D-DI? Monitor? |
3A4 and 2D6
AE: Weight Gain (more common if BMI <23) DDI: Fluoxetine, Paroxetine, Quinidine: Increase Concentration -> Decrease Dose by 50% Carbamazepine: Increase clearance -> Double Dose Valproic Acid -> Decrease concentration -> Monitor Monitor -> Rx of symptoms, BP (sit and stand), Lipid panel, Weight, waist circumference, A1C, Aims, MSE |
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Asenapine
CYP? AE? D-DI? Monitor? |
1A2
AE: Weight Gain, Hyperglycemia, EPS, Insomnia, OH, QTC, Inc Prolactin, Inc LFTs, Neutropenia, Leukopenia DDI: Class 1A, Class III, Haloperidol, Quinolone, Quetiapine, Risperidone, Ziprasidone -> QTC risk Monitor: +CBC |
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Clozapine
CYP? AE? D-DI? Monitor? |
1A2
AE: Hypersalivation, OH, Inc Blood Sugar, Wt. Gain, Agranulocytosis, Seizures (> 600mg/day) DDI: CSCEST Caffeine: Increase concentration Smoking: Decrease concentration Carbamazepine: Avoid Erythromycin: Increase concentration SSRIs: Increase toxicity Tramadol: Increase risk seizures Monitor: +CBC |
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Iloperidone
CYP? AE? D-DI? Monitor? |
3A4, 2D6
AE: Hyperglycemia, OH, Weight G, Prolactin, Neutropenia DDI: Class 1A, Class III, Quinolone, Phenothiazine Antipsychs -> QTC risk Monitor: +CBC, +Mg and K levels |
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Olanzapine
Brand? CYP? AE? D-DI? Monitor? |
Zyprexa Relprevv
1A2 AE: Weight gain, LFT, OH, Inc Blood Sugar, Inc Prolactin, Inc Trig, Cholesterol DDI: CCSF Ciprofloxacin: Inc Concentration Clomipramine: Inc Seizures -> Avoid Smoking: Dec Concentration Fluvoxamine: Inc Concentration Monitor: +LFT |
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Converting Olanzapine -> Relprevv LAI
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10 mg: 210 mg/2 week or 405 mg/4 week -> 150 mg/2 week or 300 mg/4 week
15 mg: 300 mg/2 week -> 210 mg/2 week or 405 mg/4 week 20 mg: 300 mg/2 week -> 300 mg/2 week |
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Paliperidone
Brand? CYP? AE? D-DI? Monitor? |
Invega Sustenna
2D6 and 3A4 (minor role both) AE: Prolactin, Blood Sugar, Weight Gain, QTC DDI: Class IA, Class III, Quinolone -> QTC risk avoid Monitor: EKG if over 50 y/o |
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Conversion from Paliperidone to Sustenna LAI
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3 mg -> 39-79 mg
6 mg -> 117 mg 12 mg -> 234 mg |
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Risperidone
CYP? AE? D-DI? Monitor? |
2D6
AE: Prolactin, Blood Sugar, Sexual dysfunction, Weight Gain DDI: AV Antihypertensives: Increased orthostasis Valproic Acid: Increase VPA |
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Quetiapine
CYP? AE? D-DI? Monitor? |
3A4
AE: Weight Gain, OH, Triglycerides, Blood Sugar DDI: CYP3A4 inhibitors (erythromycin and ketaconazole): Inc Concentration Monitor: +Eye Exam 4-6 weeks within starting and Q year |
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Ziprasidone
CYP? AE? D-DI? Monitor? |
3A4 and 1A2 (minor), aldehyde oxidase
AE: GQ Inc Glucose, QTC No Prolactin or Weight DDI: Azole Antifungal Class IA, III Clindamycin Macrolide Phenothiazine Quinolone TCA -> QTC risk Monitor: +Mg, K levels, EKG in every increase in dose |
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More Potent Antipsychotics
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Increase Extrapyramidal Effects
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Less Potent Antipsychotics
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More SPA: Sedation, Postural Hypotension, Anticholinergic
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Phenothiazines
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Chlorpromazine - Thorazine
Fluphenazine - Prolixin Perphenazine - Trilafon |
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Butyrophenones
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Haloperidol - Haldol
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Thioxanthenes
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Thiothixene - Navane
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Stage 1 Texas Algorithm
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Use Aripiprazole, Olanzapine, Quetiapine, Risperidone, Ziprasidone
If uncompliant: Switch to LA Depot after oral trial: Haloperidol, Fluphenazine, Risperidone |
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Adequate Trial?
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6 weeks of treatment
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Tardive Dyskinesia
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A syndrome characterized by abnormal involuntary movements occurring late in onset in relation to initiation of antipsychotic
Risk factors: Increasing age Diagnosis of organic mental disorder Diabetes Mood disorder Female gender Duration of therapy Daily dosage Treatment: *Prevention* Vitamin E therapy Regular AIMS test |
